Provider Demographics
NPI:1629010921
Name:CANCER & LEUKEMIA CENTER, PLLC
Entity type:Organization
Organization Name:CANCER & LEUKEMIA CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-323-1500
Mailing Address - Street 1:44344 DEQUINDRE RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1038
Mailing Address - Country:US
Mailing Address - Phone:586-323-1500
Mailing Address - Fax:586-323-1515
Practice Address - Street 1:44344 DEQUINDRE RD
Practice Address - Street 2:SUITE 260
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1038
Practice Address - Country:US
Practice Address - Phone:586-323-1500
Practice Address - Fax:586-323-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110F335760OtherBCBSM
MIDE0432OtherRR MEDICARE
MA110F335760OtherBCBSM